Systematic Review and Meta-Analysis of the Impact of Computed Tomography-Assessed Skeletal Muscle Mass on Outcome in Patients Awaiting or Undergoing Liver Transplantation.
van Vugt JLA, Levolger S, et al.American Journal of Transplantation 2016; 16(8): 2277-2292.
Aims
To systematically review the impact of computed tomography (CT)-assessed skeletal muscle mass on outcomes in liver transplant candidates.
Interventions
A systematic search limited to English-language articles published between January 2000 and February 2015 was conducted in EMBASE, PubMed, and Web of Science. Original studies that investigated the influence of skeletal muscle mass by means of abdominal CT in patients who underwent liver transplantation or were registered on the waiting list were eligible for inclusion.
Participants
19 studies including 3803 patients in partly overlapping cohorts, were included in this systematic review.
Outcomes
The primary measured outcome was the definition and prevalence of sarcopenia. Other measured outcomes included waiting list mortality, posttransplantation survival, posttransplantation complications and transplantation related mortality, and posttransplantation length of hospital stay.
Follow-up
Up to 5 years
CET Conclusions
This thorough systematic review assessed the impact of skeletal muscle mass measured by computed tomography (CT) on outcome in liver transplant candidates and recipients. The review was prospectively registered in PROSPERO. The comprehensive literature search identified 19 studies published between 2000-2015, including 3,803 patients. Definitions of sarcopenia varied widely between studies and the reported prevalence ranged from 22% to 70%. The review was mostly descriptive. Meta-analysis of two studies assessing the relation between skeletal muscle mass and mortality in patients awaiting liver transplantation found a pooled hazard ratio of 1.72 (95% confidence interval (CI) 0.99–3.00). Meta-analysis of 4 studies assessed the relation between skeletal muscle and posttransplant survival found a pooled hazard ratio of 1.84 (95% CI 1.11–3.05). The methodological quality was assessed using the Newcastle Ottawa scale for cohort studies which was assessed separately for short and long term outcomes and was variable across studies. The authors concluded that there was consistent evidence that sarcopenia is associated with impaired survival and less-consistent evidence that sarcopenia is associated with posttransplant complications.
Quality notes
Quality assessment not appropriate
Trial registration
Prospero ID - CRD42015019086